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1.
West Indian med. j ; 50(Suppl 5): 24, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-186

RESUMO

OBJECTIVE: The prospective comparison of a sub-cohort of persons diagnosed with schizophrenia five years from initial contact with the mental health care system in Jamaica. METHOD: In a five-year follow-up study, a sub-cohort of 54 patients (M=37, F=17 aged 15-55 years was reassessed from the initial cohort of 317 patients identified in 1992 with a CATEGO ñ diagnosis of schizophrenia. The sub-cohort was chosen from one rural parish (St.Thomas) and one mixed urban/rural parish (St.Catherine). The main outcome measures collected from case notes and patient interviews included clinical status and medication usage at contact with clinical service, employment status, outpatient clinical compliance, relapse rate, and Krawiecka and Goldberg rating scale for the severity of psychotic symptoms. RESULTS: Relapse rate at year five was 14 percent. There were no significant differences between the number of relapses in the first year and the fifth year (z= -2.714, p= 0.007, Wilcox sign test). Outpatient compliance five years from onset showed 97.3 percent of patients had been in contact with the community mental service at least twice during the five-year period. CONCLUSIONS: The favourable outcome in the fifth year after first contact is consistent with the previously reported favourable outcome in the first year after initial contact with the mental health care system in Jamaica. More importantly, the relapse rates continue to be well below the present worldwide relapse rate. (AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Adolescente , Esquizofrenia/diagnóstico , Jamaica , Seguimentos , Recidiva , Avaliação de Resultados em Cuidados de Saúde
2.
West Indian med. j ; 50(3): 198-202, Sept. 2001. tab
Artigo em Inglês | MedCarib | ID: med-302

RESUMO

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7 to 10 days for follow up. Of the 735 patients who were enrolled in the study, 319 (43.4 percent) had N gonorrhoeae and 100 (13.6 percent) had C trachomatis. Only 151 (36 percent) of the 419 patients with a pathogeneic isolate returned for clinical and microbiological assessment. The remaining 268 (64 percent) of the 419 patients were lost to follow up. One hundred and forty three patients (94.7 percent) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65 percent), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100 percent) patients who had single infection with N gonorrhoeae and in 23 patients (96 percent) with C trachomatis infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad. (AU)


Assuntos
Feminino , Humanos , Masculino , Adulto , Adolescente , Idoso , Pessoa de Meia-Idade , Gonorreia/tratamento farmacológico , Infecções por Chlamydia/tratamento farmacológico , Azitromicina/administração & dosagem , /administração & dosagem , Chlamydia trachomatis/efeitos dos fármacos , Cooperação do Paciente , Doenças Bacterianas Sexualmente Transmissíveis/tratamento farmacológico , Trinidad e Tobago/epidemiologia , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Neisseria gonorrhoeae/efeitos dos fármacos , Avaliação de Resultados em Cuidados de Saúde , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia
3.
West Indian med. j ; 50(3): 194-7, Sept. 2001.
Artigo em Inglês | MedCarib | ID: med-303

RESUMO

Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)


Assuntos
Humanos , Estudo Comparativo , Esquizofrenia/epidemiologia , Reino Unido/epidemiologia , Jamaica/epidemiologia , Afro-Americanos , Diagnóstico por Computador/estatística & dados numéricos , Estudos de Coortes , Recidiva , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Injeções Intramusculares
4.
West Indian med. j ; 49(suppl.4): 17, Nov. 9, 2000.
Artigo em Inglês | MedCarib | ID: med-389

RESUMO

OBJECTIVE: To compare the labour and delivery outcomes among mothers induced with cytotec (misoprostol) and those induced with pitocin (oxytocin) in a retrospective study. METHODS: A stratified random sample of 40 patient records of 20 mothers induced with cytotec (Group 1) and 20 with pitocin (Group 2), was selected from the records of all of the mothers (n = 148) who had induction of labour at Victoria Jubilee Hospital, Kingston, Jamaica, in March 2000. The groups were matched for age, parity and gestation. Mothers with hypertension, diabetes mellitus, sickle cell disease and multiple pregnancies were excluded. A pretested 27-item checklist, based on the standard labour and delivery records, included a list of possible antepartum, intrapartum and immediate postpartum complications and length of hospital stay. SPSS version 7.5 was used for data analysis. RESULTS: There were no significant differences in total time of labour, blood pressure, blood loss, pre- and post-induction foetal heart rates, apgar scores and length of hospital stay. Two mothers in the cytotec group had uterine hyperstimulation and were delivered by Caesarean section. Four babies in the cytotec group and three in the pitocin group were admitted for special care. CONCLUSION: Althoygh the outcome variables for mothers induced with cytotec and those induced with pitocin were similar, the two cases of uterine hyperstimulation in the cytotec group suggest caution in the use of cytotec for the induction of labour. (Au)


Assuntos
Feminino , Gravidez , Estudo Comparativo , Humanos , Trabalho de Parto Induzido , Misoprostol/análise , Ocitocina/análise , Estudos Retrospectivos , Amostragem Aleatória e Sistemática , Jamaica , Interpretação Estatística de Dados , Avaliação de Resultados em Cuidados de Saúde
5.
Psychiatric Services ; 51(5): 659-63, May 2000. tab
Artigo em Inglês | MedCarib | ID: med-547

RESUMO

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of thier illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More that half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and s everity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients, superior to the outcome of treatment in conventional psychiatric facilities.(Au)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Estudo Comparativo , Adolescente , Admissão do Paciente , Esquizofrenia/reabilitação , Doença Aguda , Estudos de Coortes , Hospitais Gerais , Hospitais Psiquiátricos , Jamaica/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente , Unidade Hospitalar de Psiquiatria , Reabilitação Vocacional , Esquizofrenia/epidemiologia
6.
West Indian med. j ; 47(Suppl. 4): 49-52, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1285

RESUMO

In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have been emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to Caribbean framework for implementing health promotion (AU)


Assuntos
Humanos , Promoção da Saúde , Região do Caribe , Educação em Saúde , Atenção Primária à Saúde , Países em Desenvolvimento , Saúde Ambiental , Comportamentos Relacionados com a Saúde , Planejamento em Saúde , Política de Saúde , Nível de Saúde , Avaliação de Resultados em Cuidados de Saúde , Desenvolvimento de Programas
7.
West Indian med. j ; 47(Suppl. 4): 16-9, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1294

RESUMO

Maternal and Child Health (MCH) policy over the past two decades has been strongly influenced by research. The paper presents examples of some of the research undertaken and its significant influence in shaping health service delivery. Research in child health has focussed on oral rehydration therapy, immunization and perinatal morbidity and mortality. On the maternal side, morbidity and mortality have been examined with particular focus on problems which contribute to maternal and perinatal morbidity and mortality. Policies arising out of the outcome of these studies have influenced organization of service delivery, information system development, manpower development and deployment, maternal education, surveillance/auditing, quality of care, design of physical facilites and selection of equipment. The results of these studies have also led to the identification of areas requiring further study and testing of intervention to correct the deficiencies identified. These studies demonstrate that research can and does influence health policy, and has impacted positively on the quality and cost of care provided through our health services.(AU)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Bem-Estar da Criança , Política de Saúde , Bem-Estar Materno , Pesquisa , Imunização , Qualidade da Assistência à Saúde , Assistência à Saúde , Hidratação , Custos de Cuidados de Saúde , Educação em Saúde , Mortalidade Infantil , Jamaica , Mortalidade Materna , Avaliação de Resultados em Cuidados de Saúde , Vigilância da População , Recém-Nascido
8.
World J Surg ; 22(12): 1192-6, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1341

RESUMO

We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45 +/- 9.4 percent vs. 48.4 +/- 8.9 percent for groups I and II respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9 percent) than in group II (52.6 +/- 4.9 percent). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group II (range 8.0 - 11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p < 0.05) compared to 9.1 +/- 2.3 for group II. Pre-PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.(Au)


Assuntos
Humanos , Serviços Médicos de Emergência , Auxiliares de Emergência , Cuidados para Prolongar a Vida , Traumatologia/educação , Ferimentos e Lesões/terapia , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Trinidad e Tobago
9.
West Indian med. j ; 47(2): 54-8, Jun. 1998.
Artigo em Inglês | MedCarib | ID: med-1801

RESUMO

We have reviewed our delivery of highly sophisticated medical therapy, haemodialysis and renal transplantation in a Caribbean setting. The purpose has been to reflect local outcomes in relation to mortality and survival, but comparisons with a vastly larger database have been attempted. Such comparisons are extremely difficult due to methodological differences and the fact that facilities contributing to that database vary considerably with regard to patient age, gender, ethnicity and comorbidity. Nonetheless, the crude data available provide important justification for the existence of regular haemodialysis and its adjunctive therapy of renal transplantation in the Caribbean.(AU)


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Nefropatias/mortalidade , Barbados , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento , Taxa de Sobrevida
10.
J Nutr ; 125(7): 1875-83, July 1995.
Artigo em Inglês | MedCarib | ID: med-5339

RESUMO

The effects of treating Trichuris trichiura infections were investigated in 407 Jamaican children age 6 to 12 years. The children were randomly assigned to receive treatment (albendazole) or a placebo. The outcome variables included growth, tests of reading, spelling and arithmetic, and school attendance. After 6 months of treatment, there was no significant main effect on any of the outcomes. However, there were significant treatment-by-infection intensity interactions with spelling (P < 0.05) and body mass index (P < 0.01), and a significant treatment-by-stunting interaction with school attendance (P < 0.01). In spelling, the children with heavy infections showed improvements with treatment that approached significance d(P = 0.06), whereas those with lower intensities did not. However, the children with lower infection intensities had increased body mass index with treatment (P = 0.02), although there was no difference in children with heavy infections. In school attendance, the stunted children improved with treatment (P < 0.04), whereas there was no difference in the nonstunted children. These findings suggest that in the sample of Jamaican children examined, the treatment of T. trichiura was more likely to benefit school performance in children of poor nutritional status and those with heavy infections, and to improve weight gain in children with lighter infection intensities (AU)


Assuntos
Criança , 21003 , Feminino , Humanos , Masculino , Albendazol/uso terapêutico , Crescimento/fisiologia , Instituições Acadêmicas/estatística & dados numéricos , Tricuríase/tratamento farmacológico , Logro , Fezes/parasitologia , Ferro/sangue , Jamaica/epidemiologia , Memória/fisiologia , Estado Nutricional , Avaliação de Resultados em Cuidados de Saúde , Tricuríase/epidemiologia , Tricuríase/fisiopatologia , Trichuris/isolamento & purificação , Incidência
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